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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426866
Report Date: 03/17/2025
Date Signed: 03/17/2025 02:12:41 PM

Document Has Been Signed on 03/17/2025 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HELPING HEARTS VISCONTIFACILITY NUMBER:
366426866
ADMINISTRATOR/
DIRECTOR:		MANUAL SOTOFACILITY TYPE:
772
ADDRESS:1288 VISCONTI DRIVETELEPHONE:
(909) 260-8515
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 10CENSUS: 9DATE:
03/17/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:55 PM
MET WITH:Valerie Daniels, Supervising Program DirectorTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 3/17/2025 at 12:55 PM, Licensing Program Analyst (LPA) Eldin Serrano conducted an unannounced case management visit to the facility to follow up on Client 1 (C1)'s death which occurred on 3/13/25. LPA initially met with Program Director Ashlee Velasquez who immediately called the Supervising Program Director (SPD) Valerie Daniels. .

LPA spoke with the SPD Valerie Daniels to obtain additional information regarding the death. LPA reviewed C1’s facility file. LPA requested copies of the following documents: Client ID/emergency information, admission's agreement, physician's report, client recovery plan/individual services and support plan, centrally stored medication log, and special incident report/death report.

The Department is requesting a copy of C1's death certificate once it becomes available. Further investigation may be required depending on the cause of death.

No deficiencies were cited during the visit. An exit interview was conducted where this report was discussed and provided to Supervising Program Director Valerie Daniels.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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